Surgical Techniques: Axillary Artery Reconstruction for ATOS
Extrinsic compression of the distal axillary artery or its immediate branches can cause unique vascular lesions that represent a variant of arterial TOS. These lesions are occasionally reported in overhead athletes, such as baseball pitchers and volleybal
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Ali Azizzadeh and Robert W. Thompson
Abstract
Extrinsic compression of the distal axillary artery or its immediate branches can cause unique vascular lesions that represent a variant of arterial TOS. These lesions are occasionally reported in overhead athletes, such as baseball pitchers and volleyball players, for whom positional compression of the artery opposite the head of the humerus has led to aneurysm formation, with thrombosis and/or embolism to the arteries of the arm or hand. The unique clinical setting of these lesions requires different considerations from those applicable to other forms of TOS or vascular disease. This chapter describes the spectrum of pathology and the outcomes of treatment for compressive axillary artery lesions, with particular emphasis on the methods of surgical treatment and the subsequent return to highperformance overhead athletic activity.
Introduction The most typical form of arterial thoracic outlet syndrome (TOS) involves development of a subclavian artery aneurysm, caused by compression of the subclavian artery within the scalene trianA. Azizzadeh, MD, FACS (*) Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School, Memorial Hermann Heart and Vascular Institute, 6400 Fannin St., Suite 2850, Houston, TX 77030, USA e-mail: [email protected] R.W. Thompson, MD Department of Surgery, Section of Vascular Surgery, Center for Thoracic Outlet Syndrome, Washington University, Barnes-Jewish Hospital, 660 S Euclid Avenue, Campus Box 8109/Suite 5101 Queeny Tower, St. Louis, MO 63110, USA e-mail: [email protected]
gle at the level of the first rib. This usually occurs in conjunction with a congenital cervical rib or first rib anomaly, with formation of mural thrombus and embolic occlusion of distal arteries in the arm and/or hand. Similar pathologic and clinical findings can develop from lesions in the distal axillary artery or its immediate branches, also caused by extrinsic compression, thereby representing a variant of arterial TOS (Fig. 86.1) [2]. Compressive lesions of the axillary artery have been occasionally reported in overhead athletes since the early 1970s, particularly in baseball pitchers and volleyball players [3–6]. The rare nature of these lesions and their unique clinical setting requires different considerations from those applicable to other forms of vascular disease. This chapter describes the spectrum of pathology and the outcomes of treatment for
K.A. Illig et al. (eds.), Thoracic Outlet Syndrome, DOI 10.1007/978-1-4471-4366-6_86, © Springer-Verlag London 2013
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A. Azizzadeh and R.W. Thompson
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Subclavian artery
Head of humerus First rib
Circumflex humeral arteries Axillary artery
Intimal Hyperplasia and Thrombotic occlusion
Subscapular artery Aneurysm formation with mural thrombus Branch vessel aneurysm
Fig. 86.1 Pathogenesis of axillary artery lesions. Compression of the third portion of the axillary artery by anterior displacement of the humeral head during the overhead throwing motion. The axi
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